Bick R L
Presbyterian Hospital of Dallas, University of Texas, Southwestern Medical Center, Texas.
Clin Lab Med. 1995 Mar;15(1):1-38.
Platelet dysfunction, especially acquired forms, is a common cause of hemorrhage, especially when associated with trauma or surgery. Although the hereditary platelet function defects are generally rare, hereditary storage pool disease is common enough to be suspected in an individual, usually a child, with characteristic historical and clinical findings. The acquired platelet function defects, especially those resulting from drugs, are very common and should promptly be suspected in patients with easy and spontaneous bruising, mild-to-moderate mucosal membrane hemorrhage, or unexplained bleeding associated with trauma or surgery. The template bleeding time is generally useful as a screening test of platelet function, but a normal template bleeding time, in the face of a suggestive history, suggestive clinical findings, or in the patient frankly bleeding, is not reliable, and platelet aggregation or lumi-aggregation should be done in applicable clinical situations. Prolongation of the template bleeding time is an unreliable predictor of clinical bleeding propensity. The mainstay of therapy for all of these defects, if bleeding is important, is the liberal infusion of suitable numbers of platelet concentrates. The acquired platelet function defects should also be managed by attempts to treat or control the underlying disease, if possible, and offending drugs or potentially offending drugs should immediately be stopped.
血小板功能障碍，尤其是获得性血小板功能障碍，是出血的常见原因，特别是与创伤或手术相关时。虽然遗传性血小板功能缺陷通常很少见，但遗传性贮存池病较为常见，对于具有典型病史和临床特征的个体（通常为儿童）应怀疑此病。获得性血小板功能缺陷，尤其是由药物引起的，非常常见，对于有易发性和自发性瘀斑、轻度至中度粘膜出血或与创伤或手术相关的不明原因出血的患者，应立即怀疑此病。模板出血时间通常作为血小板功能的筛查试验，但面对提示性病史、提示性临床特征或患者有明显出血时，正常的模板出血时间并不可靠，应在适用的临床情况下进行血小板聚集或光聚集试验。模板出血时间延长并不能可靠地预测临床出血倾向。如果出血严重，所有这些缺陷的主要治疗方法是大量输注合适数量的血小板浓缩物。对于获得性血小板功能缺陷，还应尽可能尝试治疗或控制基础疾病，并立即停用引起问题的药物或可能引起问题的药物。
